戒烟中社会支持压力缓冲模型的一项测试：社会支持与复吸时间之间的关系是否由减轻的戒断症状介导？
A test of the stress-buffering model of social support in smoking cessation: is the relationship between social support and time to relapse mediated by reduced withdrawal symptoms?
作者信息
Creswell Kasey G, Cheng Yu, Levine Michele D
机构信息
Department of Psychology, Carnegie Mellon University, Pittsburgh, PA;
Department of Statistics, University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
出版信息
Nicotine Tob Res. 2015 May;17(5):566-71. doi: 10.1093/ntr/ntu192. Epub 2014 Sep 25.
INTRODUCTION
Social support has been linked to quitting smoking, but the mechanisms by which social support affects cessation are poorly understood. The current study tested a stress-buffering model of social support, which posits that social support protects or "buffers" individuals from stress related to quitting smoking. We hypothesized that social support would be negatively associated with risk of relapse, and that this effect would be mediated by reduced withdrawal and depressive symptoms (i.e., cessation-related stress) over time. Further, we predicted that trait neuroticism would moderate this mediational effect, such that individuals high in negative affectivity would show the greatest stress-buffering effects of social support.
METHODS
Participants were weight-concerned women (n = 349) ages 18-65 enrolled in a randomized, double-blind, placebo-controlled smoking cessation trial of bupropion and cognitive behavioral therapy. Social support was assessed at baseline, and biochemically-verified abstinence, withdrawal-related symptoms, and depressive symptoms were assessed at 1-, 3-, 6-, and 12-months follow-up.
RESULTS
Social support was negatively related to risk of relapse in survival models and negatively related to withdrawal symptoms and depression in mixed effects models. These relationships held after controlling for the effects of pre-quit day negative affect and depression symptoms, assignment to treatment condition, and number of cigarettes smoked per day. A temporal mediation model showed that the effect of social support on risk of relapse was mediated by reductions in withdrawal symptoms over time but not by depression over time. Contrary to hypotheses, we did not find that neuroticism moderated this mediation effect.
CONCLUSIONS
Increased social support may buffer women from the harmful effects of cessation-related withdrawal symptoms, which in turn improve cessation outcomes.
引言
社会支持与戒烟有关，但社会支持影响戒烟的机制尚不清楚。本研究测试了社会支持的压力缓冲模型，该模型认为社会支持可以保护个体免受与戒烟相关的压力影响。我们假设社会支持与复发风险呈负相关，并且随着时间的推移，这种影响将通过减少戒断症状和抑郁症状（即与戒烟相关的压力）来介导。此外，我们预测特质神经质会调节这种中介效应，即高消极情绪的个体将表现出最大的社会支持压力缓冲效应。
方法
参与者为18至65岁关注体重的女性（n = 349），她们参加了一项关于安非他酮和认知行为疗法的随机、双盲、安慰剂对照戒烟试验。在基线时评估社会支持，并在1、3、6和12个月的随访中评估生化验证的戒烟情况、与戒断相关的症状和抑郁症状。
结果
在生存模型中，社会支持与复发风险呈负相关，在混合效应模型中，社会支持与戒断症状和抑郁呈负相关。在控制了戒烟前一天的消极情绪和抑郁症状、治疗条件分配以及每天吸烟数量的影响后，这些关系依然成立。一个时间中介模型表明，社会支持对复发风险的影响是通过随着时间的推移戒断症状的减少来介导的，而不是通过抑郁症状的减少来介导的。与假设相反，我们没有发现神经质调节了这种中介效应。
结论
增加社会支持可能会缓冲女性免受与戒烟相关的戒断症状的有害影响，进而改善戒烟结果。
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